PARTICIPANT’S INFO

COMPLETE NAME

DATE OF BIRTH AGE SEX

ADDRESS

SCHOOL/ OFFICE/ ORGANIZATION

AGE LIMIT
Participants must be 16 years old and above CONTACT NUMBER

ASSUMPTION OF RISK/ WAIVER/ RELEASE

I, the undersigned, certify that I am fit to participate in the Zombie Run and Halloween Dance Party 2017. I recognize, accept and assume all risks
involved in participating in this event. I hereby waive, release, and forever discharge the Municipal Government of Agoo, event organizers, sponsors, promoters,
agents and staff from all my claims, actions or damages from my participation in the said event. I authorize to use my name, voice, picture and any information
passed by myself on this entry form to be used without payment in any broadcast, telecast, online promotion, or advertising. I also agree that the information I
have provided may be used by the sponsor, or event organizer for the purpose of promoting future and other events and for the promotion of event sponsors,
products and service.

SIGNATURE OF PARTICIPANT SIGNATURE OVER PRINTED NAME OF PARENT/ GUARDIAN

PARTICIPANT’S INFO
COMPLETE NAME

DATE OF BIRTH AGE SEX

ADDRESS

SCHOOL/ OFFICE/ ORGANIZATION

AGE LIMIT
Participants must be 16 years old and above CONTACT NUMBER

ASSUMPTION OF RISK/ WAIVER/ RELEASE

I, the undersigned, certify that I am fit to participate in the Zombie Run and Halloween Dance Party 2017. I recognize, accept and assume all risks
involved in participating in this event. I hereby waive, release, and forever discharge the Municipal Government of Agoo, event organizers, sponsors, promoters,
agents and staff from all my claims, actions or damages from my participation in the said event. I authorize to use my name, voice, picture and any information
passed by myself on this entry form to be used without payment in any broadcast, telecast, online promotion, or advertising. I also agree that the information I
have provided may be used by the sponsor, or event organizer for the purpose of promoting future and other events and for the promotion of event sponsors,
products and service.

SIGNATURE OF PARTICIPANT SIGNATURE OVER PRINTED NAME OF PARENT/ GUARDIAN